Can we Train Patients With Chronic Stroke Out of Abnormal Hand Synergy?

Johns Hopkins University

Status: Completed

Conditions: Cerebral Stroke

Treatments: Behavioral: Configuration task

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT03255590

2R01HD053793-09A1 (U.S. NIH Grant/Contract)

NA_00082367

Details and patient eligibility

About

This study plans to determine whether training can change abnormal flexion synergy in chronic stroke patients.

Full description

The aim of the current study is to investigate whether motor training in chronic stroke patients can change their abnormal flexion synergy. The investigators will study chronic stroke patients , who are defined as patients that sustained a stroke at least 6 months prior to our testing date.

Three functional aspects of each finger will be tested: maximal voluntary contraction (MVC), finger dexterity, and hand posture.

Prior to intervention, participants will have a baseline assessment including clinical tests, MVC, the individuation task, and the configuration task. Following the baseline assessment patients will receive intervention, training on the configuration task for 5 consecutive days. On the sixth day and as a one week follow-up after, subjects will have a post-intervention assessment containing the same tests performed in baseline.

This design will allow us to determine speed and accuracy during the configuration task, the individuation index, and possible changes in abnormal flexion synergy.

We initially registered the study as two arms (anodal tDCS and sham tDCS groups) but decided to make it one arm due to the number of participants we were able to recruit.

Enrollment: 20 patients

Sex: All

Ages: 21 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 21 and older
• Ischemic stroke greater than six months ago, confirmed by CT or MRI
• Residuals unilateral upper extremity weakness
• Ability to give informed consent and understand the tasks involved.
• Appearance of Flexion synergy in hand.
• Ability to extent finger at least for 5 degrees.

Exclusion criteria

• Cognitive impairment, with score on Montreal Cognitive assessment (MoCA) ≤ 20
• History of physical or neurological condition that interferes with study procedures or assessment of motor function (e.g. severe arthritis, severe neuropathy, Parkinson's disease)
• Contraindication to tDCS (deep brain stimulators or other metal in the head, skull defect, pacemaker)
• Inability to sit in a chair and perform upper limb exercises for one hour at a time
• Participation in another upper extremity rehabilitative therapy study or tDCS study during the study period
• Terminal illness
• Social and/or personal circumstances that interfere with ability to return for therapy sessions and follow up assessments
• Pregnancy
• Severe Neglect

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

---

20 participants in 1 patient group

Finger Dexterity Training

Experimental group

Description:

Chronic stroke patients (i.e. great than 6 months) with ischemic stroke confirmed by CT or MRI, residual unilateral upper extremity weakness, able to give informed consent, and able to understand the tasks involved. Participants trained for 5 consecutive days, 3 to 4 h/d, on a multi-finger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies.

Treatment:

Behavioral: Configuration task